Employees who incur workplace injuries are usually given the compensation to which they are legally entitled. Sadly, some injured workers find it extremely challenging to get workers' compensation benefits. An employer could do the unimaginable and deny an employee's legitimate claim for workers' compensation benefits after they are injured on the job.
If this happens, the injured employee must prove their right to receive benefits. An injured worker has the right to ask for a hearing with the workers' compensation commission if there is a dispute with the employer or insurance company.
The parties involved in the workers' compensation claim must go through the discovery phase before the hearing.
Five Steps to Filing a Workers’ Compensation Claim Process
Although the process for filing a workers' compensation claim is complicated, it consists of just five simple steps:
1. The Employee Reports an Injury to Their Employer
Employers should ensure that their staff knows to notify management as soon as possible if they are sick or hurt while working. In most workers' compensation cases, an injured worker must give written notice and within the reporting deadline.
Any work-related injury, including breaking an arm when slipping on a wet office floor or developing carpal tunnel syndrome from excessive typing, may be deemed eligible.
Some wounds might need urgent care or an emergency room right away. Others might need to see a doctor for a diagnosis and medical treatment.
Depending on the state and the insurer, the employee may need to seek non-emergency treatment from a medical provider that’s part of the insurer’s network in order to receive benefits.
2. The Company Assists the Injured Employee with the Necessary Paperwork and Next Steps
Once the company is notified of an employee's injury, it must inform the injured worker of their rights, workers' compensation benefits, and possibilities for returning to work.
In most states, employers will give their employees a workers’ comp claim form to fill out and return.
This form will include information about the victim's injury as well as where it happened, the timing, and the cause. The injured worker may also be ordered to fill out a first report of injury form, which the employer will then send to the workers' compensation board in their state.
Which forms are required and who is responsible for completing them depends on the state where the employer and employee are based, as well as the type of illness or injury.
3. The Employer Files the Claim Form and Keeps the Medical Records
The injured employee's doctor will also need to submit a medical report, even though the employer typically is responsible for sending the injury claim form and any supporting evidence to the workers' compensation insurance carrier.
Employers could also be required to report the injury to the workers' compensation board or division in their state. This may apply to all workplace accidents, even if an employee is not requesting workers' compensation benefits.
4. The Insurer Approves or Denies the Claims Process
Essentially, the insurance will either approve or deny the claim after it is submitted. Also, learn more about different types of workers comp claims.
If a claim is approved:
The insurer will inform the employer and contact the employee with payment information after a claim is approved. Then, the employee and their workers' compensation lawyer may:
Accept the insurance company's payout offer, which may include a portion of lost wages, disability payments, medical costs, and medicine costs.
Negotiate for a lump-sum settlement or a larger structured settlement.
If a claim is denied:
In the event that a company's workers' compensation insurer refuses to pay benefits, the employee may:
Request the insurance company's reconsideration.
File a formal appeal, usually through the state workers’ comp board or commission.
5. The Employee Returns to Work
An employee is obligated to give written notice to both their employer and the insurance after they have recovered from an injury and can return to work. The insurance company can be compelled to provide benefits for permanent disability, depending on the severity of the injury.
Many employers decide to set up a structured return-to-work program in order to get employees back at work and productive as soon as possible. These programs may involve giving an employee modified duties or educating them in new skills if they are unable to carry out their regular duties after an injury.
Witnesses and Expert Witnesses You Could Need to Prove Your Right to Workers’ Comp Benefits
Employees will need witnesses and expert witnesses to testify at a trial if the employer is unable to settle the claim. Additionally, employees could use an expert's report or witness statements to convince the workers' compensation insurance adjuster that an accident occurred on-site.
Here are some of the witnesses that could be helpful in a workers' compensation case:
Medical Experts
Medical experts, like medical records, are vital in proving the severity of a victim's injuries, the treatments they need, and their prognosis.
The treating physician, an independent doctor hired by the victim's attorney, and a physical therapist are a few of the medical experts a victim may need to retain.
Injured employees might also need to keep their medical records for future claims.
Mental Health Professionals
Victims will also need the assistance of a social worker, psychiatrist, or other mental health specialists to prove that their work-related injury requires therapy.
Occupational Experts
If employees aren't able to fulfill the duties of their past job, they might need the guidance of a vocational rehabilitation expert or another occupational expert. These experts will explain how the victim's injuries make it difficult for them to perform certain jobs, and they will help them pinpoint any possible future careers.
Workers' Comp Won't Pay for:
Below are the injuries that a workers' compensation form won't pay for:
Stress or other psychiatric injuries
Self-inflicted injuries
Injuries caused by fighting or horseplay
Injuries that happen while commuting to or from work
Can an Attorney Help You Recover Evidence to Prove You Were Injured on the Job?
If a victim's workers' compensation claim is rejected or the victim runs into problems, they may find it beneficial to hire Des Moines workmans compensation lawyers. Employees could get help from qualified workers' compensation lawyers in collecting evidence to prove that their injury occurred at work.
When Should You Hire an Experienced Legal Team for Workers Compensation Cases?
In summary, every workers' compensation case differs depending on the injuries that the employee sustained.
If an employee was injured on the job or within the scope of their employment, they most certainly qualify for workers' compensation payments. This includes occupational diseases or illnesses brought on by being exposed to dangerous chemicals or other hazards at work.
Contact Tom Fowler Law for a free consultation today!